Research Report

A SHORT REVIEW OF ACUPUNCTURE AND

BRONCHIAL ASTHMA — WESTERN
AND TRADITIONAL CHINESE
MEDICINE CONCEPTS
Shirley P.C. Ngai, BSc; Christina W.Y. Hui-Chan, PhD; Alice Y.M. Jones, PhD, FACP

Abstract: Bronchial asthma, a chronic inflammatory airway disorder characterized by reversible airway obstruc-
tion, is traditionally managed by pharmacological intervention. Despite asthma receiving extensive global atten-
tion, the mortality rate remains at unacceptable levels. Over reliance on medication and associated adverse
drug effects have led to exploration of alternative management modalities. The effects of acupuncture and
moxibustion, a branch of traditional Chinese medicine, in the management of asthma have been extensively
reported over the last few decades. This review provides a general overview of the Western and Chinese con-
cepts of management of asthmatic symptoms and, in particular, the use of acupuncture in the management
of asthma.

Key words: acupuncture, asthma, traditional Chinese medicine

Introduction Western Medicine Concepts of

Asthma is an inflammatory disorder of the airway affect-
ing both adults and children [1]. While bronchial asthma
is a chronic condition characterized by reversible airway
obstruction, an acute asthma attack may be fatal [2].
Despite global efforts to optimize asthma control, as epito-
mized by the Global Initiative for Asthma (GINA) [3] and
Gaining Optimal Asthma Control (GOAL) [4], the preva-
lence of asthma, its associated hospitalization rate and
medical costs are still on the rise. In 2001, the reported
prevalence of asthma in children ranged from 1.6% to
35% worldwide, while that in adults ranged from 4.1%
to 32% in Europe [5]. In Europe, the annual per patient
cost was reported to range from e463 to e789 [6], and in
Hong Kong, the recent annual per patient cost has been
reported to be as high as US$1,010 [7].
Asthma Management
In Western medicine, asthma is classified as an inflam-
matory disease because airway narrowing is associated
with changes in the levels of eosinophils, mast cells,
lymphocytes, cytokines and other inflammatory cell
products [8–11]. It is well known that patients with
asthma have high levels of specific IgE that binds to
receptors of mast cells and other inflammatory cells
[12]. Interaction between IgE antibody and antigen
results in the activation of a series of inflammatory
cellular reactions, including the release of preformed
mediators (such as histamines, prostaglandins and
leukotrienes), which subsequently lead to contraction
of airway smooth muscle and bronchoconstriction
[11,13].

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
Received: 18 July 2006 Accepted: 12 November 2006
Reprint requests and correspondence to: Professor Alice Jones, Department of Rehabilitation Sciences, The Hong Kong
Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
E-mail: rsajones@polyu.edu.hk

28 Hong Kong Physiotherapy Journal • Volume 24 • 2006

©2006 Elsevier. All rights reserved.
 Patients with exercise-induced asthma are believed to
be sensitive to thermal and osmotic changes in the air-
way [14]. Velocity of airflow is increased during exer-
cise, and this leads to airway cooling that subsequently
induces mucosal drying. This increased osmolarity of
the epithelial cells in the lining of the airway induces
degranulation of mast cells and release of inflammatory
mediators leading to airway obstruction [14,15]. Rapid
airway re-warming after exercise is believed to induce
vascular congestion and increased epithelial cellular per-
meability, which causes oedema of the airway mucosa
leading to airflow obstruction [14,16].
The major aims of management of patients suffering
from mild to moderate asthma is to minimize symptoms
of wheezing, cough, dyspnoea, and the sensation of chest
tightness [1,11,13,17,18]; permit unrestricted exercise
and prevent exacerbations. For patients with severe
asthma, the aim is to achieve the highest possible stable
peak expiratory flow rate (PEFR) and maximize exercise
capacity [1,17].
In Western medicine, pharmacological treatment is
the mainstay of management. Medications for patients
with asthma include bronchodilators (β2 adrenoceptor
agonists) for relief of symptoms (termed “relievers”) and
anti-inflammatory drugs for suppression and stabiliza-
tion of the underlying inflammatory process (termed
“preventers”) [18].
The British Thoracic Society recommends a five-step
approach to therapy, depending on the severity of the
asthma condition [17].
• Step 1: Mild intermittent asthma — inhaled short-
acting β2 adrenoceptor agonists.
• Step 2: Regular preventer therapy — start at dose of
inhaled steroid appropriate to severity of disease.
• Step 3: Add-on therapy — add inhaled long-acting
β2 agonist.
• Step 4: Persistent poor control — consider increasing
the dosage of inhaled steroid and/or addition of a
fourth drug.
• Step 5: Continuous or frequent use of oral steroid —
use daily steroid tablet in lowest dose to provide
adequate control, maintain high dose inhaled
steroid as in Step 4; consider other treatments to
minimize the use of steroid tablets.
The British Thoracic Society also recommended that a
treatment regimen likely to achieve rapid symptomatic
control should be adopted initially and then the patient
can “step down” from the initial regimen [17].
Current medical therapy comprising bronchodilators
and anti-inflammatory drugs, though effective, are also
known to be associated with adverse side effects [2,19].
β2 adrenoceptor agonists are known to cause tremors,
palpitations and muscle cramps, but the main concern
associated with the use of β2 adrenoceptor agonists is
over-reliance on the drug by patients and a masking of
the severity of the condition by relief of symptoms, rather
Hong Kong Physiotherapy Journal • Volume 24 • 2006
than control of the underlying inflammatory process.
Long-term reliance on medicines is associated with an
increased risk of mortality [2,19]. Low dose steroids do
not have any significant side effects, apart from oropha-
ryngeal candidiasis and hoarseness of voice. Suppression
of adrenal function and increased osteoporosis have been
reported in some patients on high doses of inhaled
steroids [2,19]. However, the side effects associated with
anti-asthmatic medications have led to increasing
attention being paid to alternative methods of asthma
management.
Traditional Chinese Medicine Concepts
of Asthma Management
Based on the concept of traditional Chinese medicine
(TCM), health is maintained by a balance between yin
and yang and the free flow of energy, commonly known
as qi or chi [20]. Any disturbance to the balance of qi in
the system will lead to illness. Meridians are paths along
which qi passes, and acupuncture points located on the
meridians are believed to be the gateways to restoration
of yin and yang and the free flow of qi. There are 12 main
meridians and eight “extra” meridians in the body. The
12 main meridians are named after important organs.
Organs are categorized under Zang and Fu. The Zang
organs include the heart, pericardium (although strictly
speaking, pericardium is not regarded as a true Zang
organ but as an attachment to the heart to protect it from
the invasion of external pathologic factors), liver, spleen,
lung and kidney [21,22]. The Fu organs include the gall-
bladder, stomach, small intestine, large intestine, bladder
and “triple energizer”.
The triple energizer is believed to control water circu-
lation within the body and can be divided into three parts:
Upper Energizer (upper jiao) — which contains the
lungs and heart and is known as the “Chamber of Mist”;
Middle Energizer (middle jiao) — which contains the
spleen and stomach and is known as the “Chamber of
Maceration”; and Lower Energizer (lower jiao) — which
contains the kidney and bladder and is known as the
“Drainage Ditch” [21,22]. Only two of the eight extra
meridians are commonly used for manipulation of qi bal-
ance, these are the “Conceptual Vessel” and “Governor
Vessel”, which lie in the midline at the front and back of
the body [22,23].
According to TCM, asthma is a condition which results
from either excessive or deficient qi in the respiratory sys-
tem. Diagnosis of the condition is made using four diag-
nostic methods: inspection, auscultation and olfaction,
inquiring, and palpation [22,23]. Inspection requires
observation of the systemic and regional changes in the
patient’s vitality, colour, appearance, five sense organs
and tongue. Auscultation and olfaction determine the
pathological changes by listening to speech (strength,
29
loudness, clearness, speed), abnormal sounds (hiccup,
wheezing, sighing, coughing), and smelling the patient’s
breath, secretion and excretion. Inquiry involves ques-
tioning the patient to determine subjective symptoms and
progression of the illness. Palpation assesses the patholog-
ical condition by feeling the pulse and skin palpation. In
TCM, pulses are differentiated by depth (superficial or
deep), speed (rapid or slow), strength (forceful or weak),
shape (thick or thready) and rhythm (regular or irregu-
lar). Different pulse conditions are associated with differ-
ent syndromes [22,23].
Disease is also affected by seven emotions and six
exogenous pathogenic factors — wind, cold, summer
heat, dampness, dryness, and fire (warmth and heat)
[21–23].
Asthma resulting from excessive respiratory qi might
be due to stagnation of the qi caused by an attack of cold
temperature and wind (called “wind-cold”), and the
patient often has a white coating of the tongue with
superficial and tense pulses. Excessive asthma might
arise from failure of the spleen leading to disturbance in
water metabolism and the production of phlegm (called
“phlegm-heat”). The lung qi stagnates because of the
phlegm. Patients with phlegm-heat often experience
rapid and shallow breathing, strong and coarse voice,
cough with thick sputum, chest tightness, fever, restless-
ness, dry mouth, thick yellow or sticky coating of the
tongue, and rolling and rapid pulses [22,24].
Deficient asthma may be due to qi deficiency in either
the lungs or kidneys. Lung deficiency type asthma is
caused by a weakening of qi in the lungs, associated with
short and rapid breathing, prolonged and weak cough-
ing, and feeble voice. Patients often experience excessive
sweating on mild exertion, with pale tongues and weak
pulses [22,24]. Kidney deficiency type asthma is caused
by overwork or sexual indulgence which injures the
kidneys [22,24]. The main symptoms are dyspnoea on
exertion, severe wheezing and shortness of breath. Cold
extremities, pale tongue, deep and thready pulses are
the common signs of weakened kidney qi.
Use of Acupuncture in Asthma
Management
Acupuncture has been used for thousands of years for
management of organ dysfunction [22,25,26]. Stimu-
lation of acupuncture points is believed to restore normal
body function by replenishing and allowing free flow
of qi, and maintaining the balance of yin and yang
[21–24,26].
The basic principle of acupuncture is to select points
on the meridians that are responsible for the specific
organ with dysfunction. Manipulative technique can
be divided into “tonifying” (reinforcing) and “reducing”
(sedating). The tonifying method is designed to invigorate
30
body resistance and strengthen weakened physiological
function and is often used for deficient asthma syndrome.
The reducing method is used to eliminate pathogenic fac-
tors and harmonize hyperactive physiological functions
and is therefore for excessive asthma syndrome [23]. In
the management of asthma, maintenance of a smooth
flow of qi along the Lung and Large Intestine meridians
are aimed at [22,24]. Stimulation of acupoints on the
Conceptual Vessel and Governor Vessel (extra meridians)
is believed to have a qi-tonifying effect for deficiency
type asthma.
Since the signs and symptoms of asthma vary
between individuals, the selection of acupuncture points
depends on the findings of the four methods of assess-
ment. Acupuncture points chosen for the same disease
in different patients may vary [22–24], and the number
of acupuncture points used for each treatment, number
of treatment sessions, and duration of the treatment
programme depend on the acupuncturist’s assessment
preference [22–24].
The aim of management of wind-cold asthma is to
eliminate (sedate) the wind and cold, as well as to clear
the lung. Common points reported in the Chinese liter-
ature are BL 13 (Feishu) and BL 12 (Fengmen) on the
Bladder meridian, GV 14 (Dazhui) on the Governor
Vessel, LU 7 (Lieque) on the Lung meridian and LI 4
(Hegu) on the Large Intestine meridian [20,22,25].
Employment of the reducing technique has been fre-
quently reported in the literature, but the number of
treatment sessions in each course was not mentioned.
The aim of management of phlegm heat asthma is to
resolve phlegm, reduce heat, clear lung, and to regulate
the flow of qi. Acupoints commonly used for the reduc-
ing technique are LU 5 (Chize) on the Lung meridian, ST
40 (Fenglong) on the Stomach meridian, BL 13 (Feishu)
on the Bladder meridian, CV 22 (Tianti) on the Con-
ceptual Vessel, and EX 14 (Dingchuan, an extra point
not located on any of the meridians) [22,24].
For management of lung deficient type of asthma, the
aim is to strengthen lung qi. A tonifying technique using
the reinforcing method is often employed. Acupoints
commonly reported are LU 9 (Taiyuan) on the Lung
meridian, BL 13 (Feishu) on the Bladder meridian, SP 3
(Taibai) on the Spleen meridian, and ST 36 (Zusanli) on
the Stomach meridian.
The relationship between the five elements (metal,
wood, water, fire, earth) can be inter-promoted. For
example, earth can promote metal. Lung pertains to
metal and spleen pertains to earth; therefore, points
along the Spleen meridian such as the Taibai (SP 3), and
Zusanli (ST 36), are often reinforced to strengthen lung
qi [22,24,25].
The aim of management of kidney deficiency type of
asthma is obviously to strengthen kidney function using
a reinforcing technique. Acupoints commonly used for
this technique are KI 3 (Taixi) on the Kidney meridian,
Hong Kong Physiotherapy Journal • Volume 24 • 2006
BL 23 (Shenshu) on the Bladder meridian, CV 17
(Tanzhong) and CV 6 (Qihai) on the Conceptual Vessel
[22,24].
Possible Mechanisms of Effect of
Acupuncture in Asthma Management
Stimulation of a combination of acupuncture points in
patients with acute bronchospasm was shown to lead to a
reduction of airway conductance and an increase in peak
flow and forced expiratory volume in 1 second (FEV1)
[29]. Application of acupuncture to patients with acute
asthma has been shown to lower respiratory resistance
measured by a pneumotachograph [30]. How acupunc-
ture actually lowers airway resistance is unknown. The
autonomic control of airways is presumably partly related
to the segmental innervation of thoracic respiratory mus-
cles. It was hypothesized that stimulation of the somatic
afferents of certain thoracic segments may influence out-
put to the sympathetic chain and cause further changes to
airway resistance [21].
Acupuncture stimulation for ten 20-minute sessions
at the points CV 17, LI 4, BL 13 and EX 14 was associated
with a reduction in IgE levels in patients with asthma [8].
More recently, acupuncture stimulation over standard
acupoints (BL 13, BL 17, LI 4, LU 7) and additional indi-
vidualized points (LU 5, LU 6, ST 36, LI 3, KI 7, SP 6, SP 9,
CV 6, CV 12, HT 7) for 12 sessions was reported to lead
to increased levels of CD3+, CD4+ and IL-8, and reduced
levels of IL-6, IL-10 and eosinophils [9]. The authors pro-
pose a modulation of the immune system by acupuncture
but the exact mechanism remains unclear.
In patients with exercise-induced asthma, it is pro-
posed that stimulation of acupuncture points triggers
neurochemical changes in the central nervous system
through the release of opioids, which subsequently
leads to a reduction of hyperventilation [20,21,28].
What Acupuncture Points to Use for
Management of Asthma
While acupuncture points are often selected based on the
four diagnostic methods in TCM, the use of acupuncture
in Western medicine often adopts a “standard point pro-
tocol” [8,25,27,28,30–39]. This refers to the use of a fixed
number of standardized acupuncture points during a clin-
ical trial for all subjects regardless of the type of asthmatic
disorder (as interpreted in TCM). These standard points
were either suggested by individual TCM acupuncturists
or based on the common points reported in research find-
ings and/or clinical trials.
A wide variation in the standard point protocols are
reported in the literature. The common points adopted in
Western research include LU 7, LI 4, BL 13, EX 14, GV 14,
Hong Kong Physiotherapy Journal • Volume 24 • 2006
ST 36 and CV 17 (Table). Of these points, EX 14 and BL
13 [8,9,25,27,28,31–33,35,37,38] appear to be used in
the majority of clinical trials. These standard points are,
however, often used in TCM for management of the
excessive type of asthma (with the exception of ST 36 and
CV 17). Stimulation of these points is believed to effec-
tively reduce both subjective symptoms and objective
signs of asthma.
There are numerous reports of the use of acupuncture
in the management of patients with asthma. Most studies
used a combination of two to six acupuncture points
[8,25,27,28,31–35,37,40], but the use of a single point
has also been reported [30,39]. The maximum number
of points reportedly used was 14 [9,38]. Inclusion of too
many acupuncture points makes it difficult to draw any
conclusions on the effect of acupuncture on disease man-
agement [20,41]. The recent trend favours using one sin-
gle point or the combination of only a few points [25,39].
The number of sessions employed in the treatment of
patients with asthma varies from one session [28,31,33–
35,37,39] to 20 sessions [25,42], with the majority
reporting one session to investigate the short-term effects
of acupuncture on asthma [28,31,33–35,37,39]. Treat-
ment duration varied from 10 minutes [30,31,34] to 60
minutes [36], with the majority applying acupuncture
for 20–30 minutes [8,9,25,27,28,35,38–40,42,43] (Table).
Many studies reported the use of placebo or sham
points as control. These were either points with no
defined energetic effect (either not an acupuncture point
or pseudo-intervention) [8,27,31–33,39,42,43] or points
located in remote meridians that are not relevant to the
disease being studied [9,28,30,34,35,40]. However, the
question of whether or not the insertion of a needle near
any acupuncture point may induce physiological changes
in the body remains unanswered.
Effectiveness of Acupuncture in the
Management of Patients with Asthma
The variety of acupuncture points used, different treat-
ment duration and sample size make comparison of the
reports difficult. Kleijien and colleagues evaluated 13
studies based on 18 predefined methodological criteria,
and applied a score out of 100 as a rating of the quality of
the study [41]. The criteria included the adequacy of study
population, intervention and measurement of effects.
Of the 13 studies, eight scored more than 50 but none
scored more than 72. However, the results of the studies
with higher scores were contradictory, making it difficult
to draw a conclusion as to the effectiveness of acupunc-
ture in the management of asthma.
Jobst and coworkers evaluated 16 reports, comparing
the methodology, outcome measures and choice of proto-
cols. In 10 studies, acupuncture was reported to be supe-
rior to placebo or sham acupuncture, whereas six studies
31
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Table. Summary of controlled studies on the effectiveness of acupuncture on asthma

Study Subjects Acupoints chosen and Sessions Outcome

Study Type Duration Results
design (n) manipulative method (n) measures

Yu Acute bronchial SB 20: asthma Site 1: ST 36 10 min 1 1) Subjective feeling of POS

1976 asthma (20 Age (15–65 yr) 4: remission Site 2a: EX 14 each breathlessness and 1) Subjective feeling
(STE) patients) Asthma history with hista- Site 2b: 4 cm lateral expiratory wheeze a) After site 1:
Histamine-induced (7–40 yr) mine challenge to site 2a 2) Lung function: FVC, Rx, Sham: no ⌬
challenge Rx: Site 1+2a FEV1 b) After site 2:
(4 patients) Placebo: Site 1+2b 3) Arterial BP Rx and Sham:
Stimulated by continuous 4) ECG and blood sample improvement of
clockwise and anti- for PaO2, pH, PaCO2 breathlessness
clockwise at 1 cycle/s and expiratory wheeze
Rx > Sham
2) Lung function:
Sig. ↑ in FEV1 and FVC
(0.025 < p < 0.05)
Isoprenaline >
Rx(Site2a) >
Sham(Site 1, Site 2b)
3) BP ↓ (p < 0.05) Site 1
4) HR ↑ (p < 0.05) Site 2a
and isoprenaline
5) PaCO2 ↓ (p < 0.05)
Site 2a and isoprenaline
Tashkin Methacholine- DB 12 Rx: LI 4, GV 14, Ex 14, 15 min 1 1) Lung function: FVC, POS
1977 induced asthma Age (16–64 yr) Waitingchuan FEV1, FEV25–75% 1) Lung function: FEV1,
(STE) (mild to Asthma ST 36, LU 7 2) Raw, Vtg, SGaw by MMFR ↑
moderate) history (not Sham: localized region body plethysmography 2) Raw, SGaw, Vtg ↑
mentioned) over scapulae, anterior 3) Single breath diffusing (p < 0.05125)
tibia and dorsum of hand capacity for CO2 and 3) BP, HR, RR: no ⌬
Manipulate every 3–4 min HR, RR, BP Isoproterenol > Rx >
Sham
Dias Chronic asthma DB 20 Rx: RN 22, LU 7, EX-BW 1 30 min Rx: 4–12 1) Lung function NEG
1982 Age (18–73 yr) Sham: GB 5, GB 6 Sham: 2) Drug use No sig. diff. in the 3
(STE) Asthma history 2–8 3) Subjective parameters in both
(1–41 yr) assessment groups

Hong Kong Physiotherapy Journal • Volume 24 • 2006

 Takishima Acute asthma SB 10 Rx: ST 10 with EA 2 Hz 5 min placebo 2–3 1) RR POS
1982 Age (41–66 yr) Placebo acupoints: acupoints, rest 2) Subjective 1) RR sig. ↓ (10/26)
(STE) Asthma history C4 transverse 5 mins, 10 min improvement 2) Subjective
(3–25 yr) process + EA placebo stimulation, improvement
Placebo stimulation: 10 min acupoints (20/26)
ST 10 stimulation
No EA, with light massage
on the puncture skin
Chow Exercise-induced SB 16 2 points on external ear: Remove when patient 1 Lung function BOTH
1983 asthma Age (8–13 yr) Rx: lung point (asthma) has recovered from Lung function: no sig.
(STE) Asthma Sham: lumbago bronchoconstriction × 2 diff. between FEV1, V50
history (not Rotate manually clockwise and V25 before and after
mentioned) and anticlockwise at Rx and Sham
1 cycle/s, repeated No improvement in
twice in 10 min dyspnoea after exercise
in both groups
↓ FEV1 after exercise is
less in Rx > Sham

Hong Kong Physiotherapy Journal • Volume 24 • 2006

when compared with
control, but no sig. diff.
Christensen Stable chronic DB 17 Rx: CV 17, LI 4, BL 13, 20 min 10 over 1) Lung function: POS
1984 bronchial Age (19–48 yr) Ex 14 5 wk MPEFR, EPEFR 1) MPEFR, EPEFR:
(LTE) asthma Pre-Rx: 2 wk EA 4 hz/100 hz 2) Medication: no. of Rx: sig. ↑ (p < 0.05)
Rx: 5 wk Placebo: loci outside puffs of β-agonist Placebo: no sig. ⌬
Post-Rx: 4 wk segmental dermatome 3) Subjective asthma 2) Medication:
Asthma associated with loci used symptoms (DSA), Rx: sig. ↓ no. of puff
history (not in Rx group where no weekly severity of (p < 0.01)
mentioned) skin resistance asthma (WSA) Placebo: no sig. diff.
EA without impulses 4) Immunological: 3) DSA, WSA:
haemoglobin, Rx: sig. ↓ DSA
leucocyte count, Sig. ↑ WSA (p < 0.01)
orosomucoid, Placebo: no sig. diff. in
eosinophil count, both DSA, WSA
IgG, IgE, IgA, 4) Immunological
IgM Rx: Sig. ↓ IgE (p < 0.01)
Placebo: no sig. diff.
Other parameters: no ⌬

(Contd.)

33
34
Table. (Continued)

Study Subjects Acupoints chosen and Sessions Outcome

Study Type Duration Results
design (n) manipulative method (n) measures

Tashkin Stable chronic DB 26 Rx: LI 4, GV 14, EX 14, ST 15 min 8 over 1) Patient diary for S/S NEG
1985 asthma Age (8–73 yr) 36, LU 7, Waitingchuan 4 wk 2) Medication But trend to show that
(LTE) (moderate Asthma history Placebo: in the vicinity of 3) No. of attack there is improvement
to severe) (3–59 yr) real acupuncture loci but 4) Lung function: FEV1, over subjective,
Pre-Rx: 4 wk at precisely localized FVC1, FEV25–75% objective and
Real/Placebo: 4 wk region over scapulae, Raw, Vtg SGaw (3 hr medical measures
FU, no Rx: 3 wk anterior tibia and dorsum after Rx/Pl)
Placebo/Real: 4 wk of hand where no 5) HR, BP
FU, no Rx: 3 wk acupuncture loci exist
Manipulate every 3–4 min
Fung Exercise-induced DB 19 Rx: EX 14, LU 6, KI 3 20 min 1 Lung function: FEV1, POS
1986 asthma (mode- Age (9–13.5 yr) Sham: Neighbouring (before FVC, PEFR before and Lung function:
(STE) rately severe) Asthma dermatome exercise) after exercise every Real and Sham: ↓% fall
history (not SI 14, PC 4, GB 39 2 min for 15 min, and in FEV1, FVC, PEFR
mentioned) Rotate clockwise, anti- every 5 min during after exercise (Real >
clockwise for 30 s, exercise Sham) (p < 0.01)
every 5 min
Tandon Histamine-induced DB 16 non- Rx: Ex 14, CV 17, LU 6, LU 7 20 min 1 Lung function: FEV1, FVC NEG
1989 asthma (moder- Age (11–60 yr) smoker Sham: TE 5, ST 25, GB 34 Lung function:
(STE) ately severe) on Asthma history Rotate clockwise and anti- No sig. diff. in all aspects:
regular medication (3–55 yr) clockwise every 5 min FEV1, FVC, PC20
Sternfield Extrinsic bronchial Unblinded (age & 9 2 prescriptions: 30–60 min 10 (3 every 1) Skin test POS
1989 asthma asthma history A: GB 20, GV 14, LI 11, 2nd day, 2) Complete blood count 1) Lung function: no sig. ⌬
(LTE) not mentioned) ST 36, SP 6, KI 7, EX 14 rests are 3) Total IgE 2) Total IgE, prick skin
B: LU 1, CV 17, CV2 2, twice 4) Lung function test: no ⌬
LU 9 weekly 5) LTC4-induced LAI 3) 57% of positive LTC4-
6) Self measured peak induced LAI response
flow rate bare negated
4) Medication: sig. ↓
dose of bronchodilators
in all patients, all
stopped steroid
Zang Bronchial asthma Unblinded 192 LU 6, LU 10 40 min 1 Clinical observation of S/S POS
1990 (outcome study) Age not mentioned Manipulate with reducing such as dyspnoea, 76.5% clinical remission
(STE) Asthma history method + EA 160 Hz wheezing or marked improvement
(4 mo–45 yr)

Hong Kong Physiotherapy Journal • Volume 24 • 2006

 Zwolfer Bronchial asthma Unblinded 22 (17) Rx: HT 3, SI 3, BL 13, BL 17, 20 min 10 weekly Questionnaire (1st Rx, POS
1993 (outcome study) Mean age 52.2 yr KI 27, TE 5, TE 15, LR 13, 10th Rx and half a year) 70% S/S ↓
(LTE) Asthma history LU 1, LU 2, LU 7, LI 4, ST 13,
(> 5 yr) CV 17 (12–14 needles)
Biernacki Stable chronic DB 23 non- Rx: CV 17 20 min 1 1) AQLQ BOTH
1998 asthma (mild Age (43 ± 15 yr) smoker Sham: nonspecific single 2) Usage of bronchodilator 1) Stat. sig. ↑ AQLQ scores
(STE) to moderate) Asthma point of unrecognized 3) MPEFR, EPEFR (daily) in all domains in both Rx
history (not value on the chest wall 4) Lung function: FEV1, and Sham (Sham > Rx)
mentioned) FVC, PEFR (measure 2) Sig. ↓ bronchodilator
before, after 30 min, in both (Sham > Rx)
45 min, 60 min) 3) Home measured PEFR:
no sig. ⌬
4) No sig. ⌬ in spirometric
values acutely or 60 min
later for both groups
Joos Mild to moderate SB 38 Based on TCM Dx method 30 min 12 times 1) Subjective: general POS
2000 bronchial asthma Age (16–65 yr) Rx: 20 Max 16 needles over 4 wk wellbeing 1) General wellbeing:
(STE) Asthma history Control: 18 Rx: 2) Blood samples: eosino- sig. ↑ (Real > Sham)

Hong Kong Physiotherapy Journal • Volume 24 • 2006

(1–20 yr) Basic: BL 13, BL 17, phils, lymphocyte sub- 2) Blood parameters:
LI 4, LU 7 population, cytokines, Real: CD3+, CD4+ sig. ↑;
Add on: LU 5, LU 6, ST 36, lymphocyte proliferation IL6, IL10 sig. ↓; IL8
LI 3, KI 7, SP 6, SP 9, before and after Rx sig. ↑; eosinophils
CV 6, CV 12, HT 7 sig. ↓; (p < 0.05)
Depth: 0.3–3 cm
Control: Sham: no change except
Basic: TE 3, TE 9, GB 8, GB 34 CD4+ (p < 0.05)
Add on: BL 38, BL 55, ST 4,
ST 6, ST 32, TE 14,
TE 23, SI 5
Depth: < 1 cm
Shapira Chronic asthma SB 23 Rx: 20–30 min 4 sessions 1) Lung function: FEV1 NEG
2002 (moderate) Age (18–58 yr) 1st, 4th: points designed for in 2 wk 2) Daily peak flow 1) Lung function: no sig. ⌬
(STE) Methacholine Asthma acute attack of asthma variability in FEV1 before and
challenge history (not 2nd, 3rd: points designed for 3) Asthma diary after treatment and
mentioned) treating root of asthma methacholine challenge
(diagnosed by TCM) in both groups
Sham: 2) PF variability: no sig. ⌬
Places other than acupuncture (both groups)
points on the back, shoulder, 3) No sig. ⌬ in both
the extremities at angle of 10° to 30° medication and S/S
and directed subcutaneously
Manipulated 1–2 times
during session

35
(Contd.)
36
Table. (Continued)

Study Subjects Acupoints chosen and Sessions Outcome

Study Type Duration Results
design (n) manipulative method (n) measures

Medici Allergic bronchial DB 66 Real Rx: 20 min 8 over 4 wk 1) Lung function: PEF BOTH
2002 asthma (mild to Age (16–70 yr) Real: 23 GV 14, EX 14, BL 13, KI 3, (twice 1 wk variability, FEV1 1) PEF ↓ in all groups:
(LTE) moderate) Asthma S: 23 SP 6, LI 4, LI 11, ST 36, and 2 mo 2) Airway responsiveness but no diff. btw sham
Excess type in TCM history (not No: 20 LR 13, LU 10, PC 6 apart, start 3) Asthma responsiveness and real
mentioned) Sham: another 4) Use of asthma drugs 2) Most of the other
Vicinity of real acupuncture 4 wk (total 5) Patient’s wellbeing functional and clinical
points but at precisely 16 sessions) 6) Eosinophils and ECP in variables did not differ
localized regions where blood and sputum from those obtained in
no acupoints exist controls
Manipulate 30 times 3) Eosinophils and
every 5 min ECP in blood and
sputum ↓ sign
4m btw sham and
control and 10m btw
sham and real
Malmstrom Mild asthma SB 27 Rx: LU 5, LU 6, LU 7, PC 6, 30 min 20 Lung function NEG
2002 Age (33–48 yr) CV 17, BL 13, GV 20, No sig. diff. before and
(LTE) Asthma ST 36, ST 40, KI 3 after IHCA (p > 0.05)
history (not (↑ from 5 to 16) in both groups
mentioned) Control: mock TENS
Maa Stable chronic Unblinded 41 Gp 1: control (standard care) Gp 2: 30 min Gp 2: 20 1) 6MWD BOTH
2003 asthma Mean age 64 yr Gp 2: acupuncture + (10 s manual Gp 3: daily 2) DVAS SGRQ score sig. ↑ in Gp 2
(STE) Asthma standard care manipulation) 3) Modified Borg Scale, and Gp 3; no sig. diff.
history > 3 yr Rx: LU 1, DU 14, EX 14, Gp 3: 30 s to SGRQ in other parameters
ST 36, PC 6 2 min each 4) BESC
Gp 3: acupressure +
standard care

STE = short-term effect; LTE = long-term effect; POS = positive findings; NEG = negative findings; BOTH = both positive and negative findings; BP = blood pressure; HR = heart rate; RR = respiratory rate;
sig. = significant; diff. = difference; btw = between; ECP = eosinophil cationic protein; TENS = transcutaneous electrical nerve stimulation; 6MWD = 6-minute walking distance; DVAS = Dyspnoea Visual
Analogue Scale; SGRQ = St George’s Respiratory Questionnaire; BESC = Bronchitis Emphysema Symptom Checklist.

Hong Kong Physiotherapy Journal • Volume 24 • 2006

showed that there was no difference between acupunc-
ture and sham acupuncture or the results were equivocal
[44]. The authors concluded that acupuncture may be
effective in alleviating the signs and symptoms of asthma
and could be used as an adjunct to conventional medical
management of asthma, but would not recommend it to
be the sole treatment of asthma [44].
Another review reported the effectiveness of acupunc-
ture on the management of asthma based on 10 ran-
domized controlled clinical trials. Nine of the 10 trials
investigated showed positive short-term improvement of
lung function and a subsequent decrease in the use of
medication [45]. The authors suggested that acupuncture
may be effective in relieving asthma symptoms on a short-
term basis. A recent Cochrane review [46] of 11 random-
ized controlled trials evaluated the long-term effect of
acupuncture treatment of duration longer than 1 week.
Assessment criteria included type of study, number of
participants and outcome measures (e.g. lung function
test and/or medication use and quality of life). With the
inconsistencies in methodology and results obtained
among the studies, there was inconclusive evidence to
make recommendations about the value of acupuncture
in the treatment of asthma. Future research with clear
reporting of the severity of the asthma condition, and
details of acupuncture intervention including treatment
duration, number of sessions and standard acupoints
chosen were suggested.
Possible Side Effects of Acupuncture
There were no reported side effects associated with
the application of acupuncture stimulation. However,
there were reported complications associated with the
acupuncture technique. The most common complica-
tions included pneumothorax, stab injuries of internal
organs (especially the lungs), infection, vasovagal reac-
tion, recurrent asthma attack with hypertension, angina
and other neurovascular injuries [47–50]. Although only
a few cases were reported, the consequences were severe.
Minor complications such as bleeding, haematoma,
needling pain, faintness and drowsiness were more fre-
quently reported and may be related to inexperience of
the acupuncturist and inaccurate techniques being used
[50,51].
Summary
Acupuncture has been used for the management of
asthma for thousands of years in China. The effectiveness
of acupuncture has been investigated by many Western
researchers. The majority of reports suggest positive out-
comes with acupuncture, in terms of either symptom
alleviation or improvement in objective measures such as
Hong Kong Physiotherapy Journal • Volume 24 • 2006
lung function, airway resistance, exercise capacity and
immunological status. Most trials, however, focused on
the short-term and immediate effects of acupuncture.
Small sample size, involvement of too many acupunc-
ture points, non-standardized treatment frequency and
variable duration of treatment have resulted in many
negative and inconclusive findings. Furthermore, it is
possible that sham acupuncture points may unintention-
ally induce similar changes as actual acupuncture point
stimulation. The direction for future research regarding
the use of acupuncture in patients with asthma should
focus on adopting consistent treatment protocols, using
fewer acupuncture points, maximizing sample size and
investigating the long-term effects of acupuncture on
asthma.
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